Future fertility for young cancer patients preserved with procedure from U of C researchers

Uptake has increased drastically in the past year for a recent medical program established by University of Calgary researchers to offer the option for young cancer survivors to have biological children.

University of Calgary researchers have introduced an ovarian tissue cryopreservation (OTC) program, which is the first of its kind in Alberta. The procedure is meant for children and adolescents with ovaries who are facing treatments that could affect their fertility, like chemotherapy or radiation therapy, and offers the option to have their eggs frozen.

Dr. Shu Foong, a clinical assistant professor at the U of C's Cumming School of Medicine and medical director of the regional fertility program, said OTC has been offered in Calgary since the procedure was no longer deemed experimental in Canada in 2020. Its use has increased recently as 80 per cent of patients who have ever gone through the program since it was first introduced have undergone the procedure in the past year.

OTC involves removing a portion of the patient's ovary through laparoscopy, using a camera and small incisions in the abdomen, before cancer treatment begins. Slow freezing is then used to preserve the tissue, to implant it back in the patient in the future. 

The technique is still relatively new, and Calgary is one of a few cities in Canada to offer the procedure for patients facing high-risk treatment. While there have been no patients in Canada who have had their tissue re-implanted yet, more than 200 live births around the world have resulted from OTC, Foong said.

"This is truly a novel technique that's available, but also the only option for prepubertal children up until this time," Foong told reporters on Monday.

The program, developed by U of C researchers, is now available at the Alberta Children's Hospital. The procedure has been a research interest for Foong for nearly a decade. In that time, she and her team have thawed experimental tissue to ensure its integrity, and have been happy with the results.

Chemotherapy and radiation therapy can otherwise cause patients to delay puberty or undergo early menopause. The goal of OTC, Foong said, is to offer hope for young cancer patients to have the option to have a biological child later in life.

"It is our way to say, as a medical community, that there is hope, that we do believe in the ability for them to fight this and to look forward to the future," Foong said.

Foong added there's also ongoing research into offering similar tissue preservation for young patients with testes, and that research is ongoing into growing eggs in the lab from the tissue, without needing to re-implant it.

Future family planning and the fertility problems that treatments like chemotherapy can cause is a common and difficult conversation for families when a young person is diagnosed with cancer, said Dr. Greg Guilcher. 

Guilcher is an associate professor of oncology and pediatrics and the program director for the Alberta Children's Hospital Research Institute's childhood cancer and blood disorders program.

He said that before this procedure, there weren't any fertility preservation options for these young patients.

"Hope is critically important to anyone at any phase of illness or any phase of life, but particularly if a young person is facing cancer or a life-threatening blood disorder. Just having a conversation about a future many years from now about family planning is incredibly important in fostering resilience," Guilcher said.

Guilcher added that, within the past couple of years, OTC is now also being offered to young patients set to undergo bone marrow transplants, which can also compromise a patient's fertility. This has been a barrier to treatment for some patients who have reconsidered or deferred the transplant to keep that family planning option later in life.

"To have new options where they can pursue a curative option in addition to having the possibility of fertility preservation is really practice-changing and life-changing for these families," Guilcher said.

Foong added that other jurisdictions have begun to reach out to the U of C for more information about their program, to explore the possibility of offering OTC as well.

The procedure isn't covered by Alberta Health. It costs around $3,000, plus fees, to store the tissue.

Researchers are hoping to see it covered in the future to remove barriers to access it.